Gastrostomy Tube Placement in Neonates Undergoing Congenital Heart Surgery: A Novel Assessment for Improving Utilization and Timing of Placement

2021 ◽  
Vol 12 (4) ◽  
pp. 480-486
Author(s):  
Kevin M. Beers ◽  
Aaron Bettenhausen ◽  
Thomas J. Prihoda ◽  
John H. Calhoon ◽  
S. Adil Husain
Keyword(s):  
Length Of Stay ◽  
Aortic Arch ◽  
Congenital Heart ◽  
Gastrostomy Tube ◽  
Tube Placement ◽  
Genetic Syndrome ◽  
Delayed Sternal Closure ◽  
Aortic Arch Reconstruction ◽  
Gastrostomy Tube Placement ◽  
Arch Reconstruction

Background: Neonates undergoing congenital heart defect repair require optimized nutritional support in the perioperative period. Utilization of a gastrostomy tube is not infrequent, yet optimal timing for placement is ill-defined. The objective of this study was to identify characteristics of patients whose postoperative course included gastrostomy tube placement to facilitate supplemental tube feeding following neonatal repair of congenital heart defects. Methods: A single-institution, retrospective chart review identified 64 consecutive neonates who underwent cardiac operations from 2012 to 2016. Perioperative variables were evaluated for significance in relation to gastrostomy tube placement. Results: A total of 27 (42%) underwent gastrostomy tube placement. Diagnosis of a genetic syndrome was associated with the likelihood of placement of gastrostomy tube ( P = .032), as were patients with single ventricle physiology ( P = .0013) compared to those felt to be amenable to eventual biventricular repair. Aortic arch reconstruction ( P = .029), as well as the need for delayed sternal closure ( P = .05), was associated with increased frequency of gastrostomy tube placement. Postoperative outcomes including the number of days intubated ( P = .0026) and the presence of significant dysphagia ( P = .0034) were associated with gastrostomy placement. Additionally, genetic syndrome ( P = .003), aortic arch reconstruction ( P = .01), and postoperative intubation duration ( P = .0024) correlated with increased length of stay, where increased length of stay was associated with gastrostomy tube placement ( P = .0004). Discussion: Patient characteristics that were associated with a high likelihood of eventual gastrostomy placement were identified in this study. Early recognition of such characteristics in future patients may allow for reduced time to gastrostomy tube placement, which in turn may improve perioperative growth and outcomes.

Whole body perfusion strategy for aortic arch repair under moderate hypothermia

Perfusion ◽  
2017 ◽  
Vol 33 (4) ◽  
pp. 254-263 ◽  
Author(s):  
Christopher L. Tarola ◽  
Katie L. Losenno ◽  
Jill J. Gelinas ◽  
Philip M. Jones ◽  
Philip Fernandes ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Aortic Arch ◽  
Whole Body ◽  
Moderate Hypothermia ◽  
Lower Body ◽  
Icu Length Of Stay ◽  
Icu Discharge ◽  
Aortic Arch Reconstruction ◽  
Arch Reconstruction

Introduction: Aortic arch reconstruction under moderate hypothermia is commonly performed with antegrade cerebral perfusion (ACP) for brain protection; however, hypothermia alone is often solely relied upon for visceral and lower body protection. We investigated whether the addition of simultaneous lower body perfusion to ACP (whole body perfusion - WBP) may ameliorate the metabolic derangements of moderate hypothermic circulatory arrest (MHCA). Methods: Between 2008 and 2014, 106 consecutive patients underwent elective or emergent aortic arch surgery with MHCA, with either ACP only (44 patients, 66±12 years, 30% female) or WBP (62 patients, 61±15 years, 31% female). Primary outcomes included 30-day/in-hospital mortality, intensive care unit (ICU) and hospital lengths of stay (LOS) and specific parameters of metabolic recovery. Results: There were no significant differences between the groups in 30-day/in-hospital mortality (ACP: 3 (6.8%), WBP: 2 (3.2%); p=0.65), stroke (ACP: 1 (2.3%), WBP: 1 (1.6%); p=1.0) or renal failure (ACP: 2 (4.5%), WBP: 1 (1.5%); p=0.57). In the WBP group, we identified a significant reduction in lactate level at ICU admission (ACP 5.5 vs. WBP 3.5 mmol/L; p=0.002), time to lactate normalization (p=0.014) and median ICU length-of-stay (ACP 3 vs. WBP 1 days; p=0.049). There was no difference in post-operative creatinine (ACP: 104, WBP: 107 μmol/L; p=0.66). After multivariable regression adjustment, perfusion strategy no longer remained an independent predictor of ICU discharge time (p=0.09), however, cardiopulmonary bypass time (p=0.02), age (p=0.012) and emergent surgery (p=0.02) were. Conclusions: A WBP strategy during aortic arch reconstruction with MHCA may be associated with more rapid normalization of metabolic parameters and reduced ICU length of stay compared to using ACP alone. Further evaluation with a randomized trial is warranted.

Results of aortic arch reconstruction in neonates and infants

2009 ◽  
Vol 56 (S 01) ◽  
Author(s):  
L Ben Mime ◽  
M Emmel ◽  
N Sreeram ◽  
K Brockmeier ◽  
G Bennink ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Aortic Arch Reconstruction ◽  
Neonates And Infants ◽  
Arch Reconstruction

scholarly journals Reconstruction of the Aortic Arch in Neonates and Infants: The Importance of Patch Material

2021 ◽  
Vol 12 (4) ◽  
pp. 487-491
Author(s):  
Ingrid M. van Beynum ◽  
Serife Kurul ◽  
Thomas Krasemann ◽  
Michiel Dalinghaus ◽  
Pieter van de Woestijne ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Important Determinant ◽  
Primary Repair ◽  
First Year ◽  
Aortic Arch Reconstruction ◽  
Study Population ◽  
Aortic Arch Repair ◽  
Neonates And Infants ◽  
Arch Reconstruction ◽  
First Year Of Life

Objectives: Restenosis after aortic arch reconstruction is a known complication in neonates and infants. Homograft is the most commonly used patch material for aortic arch reconstructions in our center. Since 2014, tissue-engineered bovine pericardium (CardioCel) has been used as an alternative. The aim of our study was to determine whether the choice of material affected the development of restenosis in these patients. Methods: Data of all neonates and infants who underwent aortic arch reconstruction with the use of any patch material between 2005 and 2016 were analyzed. Restenosis was defined by the need for reintervention, either percutaneous or surgical. Results: Forty-one patients underwent aortic arch repair. Excluding the 30-day mortality, 36 patients represented the study population. At primary repair, the aortic arch was reconstructed with homograft (n = 26) or CardioCel (n = 10). Restenosis was documented during the first year of life in 13 patients: Six (23%) patients in the homograft group and seven (70%) patients in the CardioCel group ( P = .01). In the homograft group, the median time from operation to first intervention for restenosis was 22.0 (range: 14-32) weeks, as compared to 14.0 (range: 7-21) weeks in the CardioCel group ( P = .04). Conclusion: We conclude that choice of patch material is likely to be an important determinant for the risk of restenosis needing reintervention following reconstruction of the aortic arch in neonates and infants.

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